Triple-modality treatment in patients with advanced stage tonsil cancer.

Abstract

BACKGROUND:

Concurrent chemoradiation (CCRT) and upfront surgery followed by adjuvant therapy both are recommended treatment options for patients with advanced stage squamous cell carcinoma (SCC) of the tonsil. To the authors' knowledge, the question of whether surgical-based treatments can achieve better survival compared with CCRT has never been compared in a clinical trial. The authors analyzed the National Cancer Data Base to measure the impact of different treatment modalities on overall survival (OS).

METHODS:

All patients aged ≤70 years diagnosed with clinical stage III to IVB (excluding T4B) SCC of the tonsil from 1998 through 2011 were selected. Analysis was limited to patients receiving CCRT, surgery plus CCRT, or surgery followed by adjuvant radiotherapy (RT). OS was compared using the Kaplan-Meier method and log-rank test. Univariable and multivariable hazards analyses were performed to identify factors significant for survival. Propensity score matching was performed.

RESULTS:

There were 16,891 patients who met the inclusion criteria. The most common treatment was CCRT (8123 patients; 48.1%), followed by surgery plus CCRT (5249; 31.1%) and surgery plus RT (3519 patients; 20.8%). Patients treated with surgery plus CCRT were found to have the highest 3-year OS rate (88.5%) followed by those treated with surgery plus RT (84%) and CCRT (74.2%) (P<.0001). In a propensity score-matched subpopulation of 4962 patients, the 3-year OS rate was 90.2% for those treated with surgery plus CCRT, 84.9% for those treated with surgery plus RT, and 82.1% for those treated with definitive CCRT (P<.0001).

CONCLUSIONS:

Patients with advanced stage SCC of the tonsil who underwent surgery followed by CCRT had the greatest OS. Patients undergoing upfront surgery may avoid chemotherapy without jeopardizing survival. Triple-modality therapy may provide a survival benefit for a subset of patients with advanced stage tonsil cancer. Cancer 2017;123:3269-76. © 2017 American Cancer Society.

• Authors: Dylan F Roden, David Schreiber, Babak Givi
• Journal: Cancer (Cancer) Vol. 123 Issue 17 Pg. 3269-3276 (Sep 01 2017) ISSN: 1097-0142 [Electronic] United States
• PMID: 28440876 (Publication Type: Journal Article)
• Copyright: © 2017 American Cancer Society.

Topics

• Aged
• Carcinoma, Squamous Cell (mortality, pathology, therapy)
• Chemoradiotherapy (methods)
• Chi-Square Distribution
• Cohort Studies
• Combined Modality Therapy
• Disease-Free Survival
• Female
• Follow-Up Studies
• Glossectomy (methods)
• Humans
• Kaplan-Meier Estimate
• Lymph Nodes (pathology, surgery)
• Male
• Multivariate Analysis
• Neoplasm Invasiveness (pathology)
• Neoplasm Staging
• Propensity Score
• Proportional Hazards Models
• Registries
• Retrospective Studies
• Risk Assessment
• Survival Analysis
• Tongue Neoplasms (mortality, pathology, therapy)
• Treatment Outcome
• United States